Health Promotion by Design in Long-Term Care Settings

Objective: To assess the relationship between physical environmental factors and resident and staff outcomes in different types of long-term-care settings.

Methods: Literature review of more than 250 peer reviewed journal articles published in different fields such as gerontology, architecture, nursing, psychology, and psychiatry. Key words used to access databases included long-term care, physical environment, homelike environment, elderly, falls, sleep, depression, quality of life, dementia, and safety.

Key Findings: The physical environment impacts outcomes among patients, their family, and staff in three main areas: (a) resident quality of life, (b) resident safety, and (c) staff stress. Several studies show that different aspects of the physical environment— such as the unit layout, supportive features and finishes, reduced noise, as well as access to outdoor spaces — may be linked to better outcomes, including improved sleep, better orientation and wayfinding, reduced aggression and disruptive behavior, increased social interaction, and increased overall satisfaction and well-being. Further, a growing body of research suggests that the environment should not only support functional abilities, but also provide opportunities for residents to be physically active and healthy. The environment can increase safety among residents by removing barriers to ambulation and performance of critical tasks and by preventing infections and unsafe behaviors such as exiting. Studies also show that if supports for work (such as ceiling lifts) are incorporated within a long-term care setting, it results in greater satisfaction, morale, and fewer work-related injuries. Design enhancements, such as a homelike ambiance, are also linked to higher satisfaction among nurses.

Conclusions: The design of the physical environment impacts resident and staff outcomes in long-term care settings and contributes to a better quality of life for those who live and work in and visit these facilities.